Provider Demographics
NPI:1427877802
Name:PETTIT, JACQUELINE SCHNEIBER (PMHNP)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:SCHNEIBER
Last Name:PETTIT
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 W 1200 S
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-6339
Mailing Address - Country:US
Mailing Address - Phone:203-962-2562
Mailing Address - Fax:
Practice Address - Street 1:86 W 1200 S
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-6339
Practice Address - Country:US
Practice Address - Phone:203-962-2562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-03
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8747557-4405363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health